Last week we learned… Why influenza is specifically harmful to dialysis patients, and… Why it is important to immunize
Today we will talk about… How to use CQI to improve vaccination rates How to identify common barriers How to develop strategies for overcoming the barriers
What is CQI? Improving quality through: –Proactive approach –Optimal orientation –Process focus
What is CQI? Improvement comes from the application of knowledge. Any approach to improvement must be based on building and applying knowledge. Significant, long-term, positive impact occur only when someone takes the initiative.
PLAN DO STUDY ACT The CQI Cycle The Cycle Never Ends…
A Cycle for Learning and Improvement ACT What changes are to be made? What will be the next cycle? PLAN State the objective Make predications Develop a plan to carry out the cycle DO Carry out the plan Document observations Analyze data STUDY Complete analysis Compare data to prediction Summarize what was learned
The IHI Model for Improvement Act Plan Do Study What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement?
Understanding the Problem Establishing a problem statement Defining the scope of the problem Refining the problem
Immunizations for Influenza 1.Where are we currently? - What does the data say? -What is the trend? 2.Where do we want to be? - What knowledge do we have? - What is our goal?
lla illi lla illi Where Are We Now? ESRD patients initiating therapy at least 90 days before September 1, 2005, & alive on December 31, 2005; vaccinations tracked between September 1 & December 31. USRDS ADR 2007
What Knowledge Do We Have? Increased susceptibility of CKD patients to pneumococcal and hepatitis B (CDC) Failure to increase rates of immunization over past 10 years (USRDS)
Where do we want to be? Healthy People 2010 Goals –Influenza = 90% –Pneumococcal = 90% –Hepatitis B = 80% Network Medical Review Board recommendations CDC Guidelines
Rules of Creativity Challenge the boundaries Rearrange the order of the steps Look for ways to smooth the flow Evaluate the purpose Visualize the idea Remove “the current way of doing things” as an option
CREATIVE CHANGE From the ground up… -Problem identification -Idea development From the top down… -Support -resources
Implementing Change When given a choice between two systems, one of which they understand, people will use what they know. If you want to truly make a change, you must present an expectation and put in place a structure to effect the change. People need information in order to change.